Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

General surgery > Post-operative complications > Flashcards

Post-operative complications Flashcards

1
Q

Potential complications

A
  1. Respiratory failure->heart and lungs
  2. Wound failure->check wound site
  3. Confusion->orientation
  4. Pyrexia->vitals
  5. Deep vein thrombosis->painful calves, mobilising, DVT prophylaxis
  6. Oliguria->urine output
  7. Hyponatremia->bloods
  8. Hypernatremia
  9. Hypo/hyperkalemia
  10. Hemorrhage
  11. Vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causes of respiratory failure

A
  1. Pulmonary embolism
  2. Acute lung injury/ARDS
  3. Abdominal distension
  4. Opiate overdose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Potential wound failures

A 
1. Discharge of fluid
(serous, blood, serosanguinous,
infected fluid)
2. Collection of fluid
(blood, pus, seroma--> large incision in SC or lymphatic damage-->lift skin off tissues and impede wound healing
3. Disruption of the wound
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Risk factors for wound breakdown

A 
1. General
DM
Immunosuppression
Malignancy
Malnutrition
2. Local
Wound closure
Infection
Foreign body
Mechanical stress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Serous versus serosnguinous from wound

A
  1. serous may be little significance
  2. Serosanguinous–> 5-8 days post may be due to dehiscience
    with evisceration. Sterile dressing
    consider taking back to surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Causes of post-operative confusion

A
  1. Hypoxia->pneumonia, PE, cariac
  2. Sepsis
  3. Drug withdrawal, drug effects
  4. Metabolic/electrolyte
  5. Urinary retention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Management of confusion

A
  1. Study charts
  2. Co-morbidities
  3. Drug/alcohol
  4. History and examine
  5. Consider oxygen
    Consider ABG, FBC/UEC/LFTs,
    blood/urine culture, CXR, echo?
  6. May need sedation->midazolam, haloperidol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Define normal temperature

A

A normal temperature is 36.5-37.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What considerations with post-op pyrexia

A
  1. Type of fever
  2. Procedure
  3. Temporal relationship
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Fever within 24 hours

A
  1. ATELECTASIS

2. Metabolic response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Fever days 5-7

A

Usually infection
Pulmonary can
Consider: infection of the wound, operative site or urinary tract
Cannula and DVT!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Fever >7 days post op

A

Abscess
Also remember–> drugs, transfusion, brainstem as cause of
+temperature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Causes of oliguria

A

Diminished output

most commonly hypovolemia
2. Intra-renal (ATN)
3. Post renal failure: Need accurate matching input and output
Most ensure not in acute urinary retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Common causes of oliguria in terms of procedure and ileus

A
  1. Underestimating fluid loss in procedure

2. Ileus->fluid becomes sequestered in the gut

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Cause of hyponatremia and management

A
  1. Mostly dilutional
  2. +ADH

Fluid restriction 2L until diuresis settles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Causes of hypernatremia and management

A 
Usually secondary to
reduced water intake
1. Administer water by mouth or
IV dextrose
2. Max reduction 10mmol/L in 24
hours redution/L dextrose= sodium concentration/ (TBW +1)
17
Q

Types of hemorrhage related to surgery

A 
Localised
1. Primary- 
within procedure
2. Reactionary- w/i
24 hours of procedure,
most commonly from
poorly ligated blood vessel
3. Secondary 7-10 days 
after operation-->most often erosion of vessel from spreading infetion, intraperitoneal bleeding, GIT hemorrhage, disordered hemostasis
18
Q

Causes of vomiting

A
  1. Drugs->immediate
  2. Gut atony->self limiting
  3. If >7 days->consider mechanical course
19
Q

Causes of post-op fever and timeframe

A 
1. Wind
Pulmonary 1-3 days
Atelectasis, pneumonia
Exacerbate pre-existing
2. Water
UTI day 3-5
3. Wound
Infection day 5-8
4. Walk
Venous->DVT, PE, Thrombophlebitis
5. Wonder drugs
Any drug can cause
20
Q

Timing of post-op fever to identify cause

A 
1. Hours after POD 1
Inflammatory
Blood reaction
Malignant hyperthermia
2. POD 1-2
!Atelectasis
Early wound
Aspiration pneumonitis
Addisonian, thyroid storm
Transfusion reaction
3. POD 3-7
UTI
Surgical site infection
Septic thrombophlebitis
Leaked anastamosis
4. POD 8
Intra-abdo abscess
DVT/PE, drug fever
Cholecystitis, peri-rectal
abscess, URTI, 
seroma/hematoma/biloma that's
infected
C dif colitis, Endocarditis
21
Q

Immediate post-operative management

A
  1. Pain and other medications
    a. analgesia,
    b. antibiotics
    (prophylactic or therapeutic),
    c. sedatives,
    d. antiemetics and
    e. anticoagulants/DVT prophylaxis–>
    ensure charted and being
    administered where relevant
  2. Monitoring
    vitals, (may include cVP),
    Fluid input and output
    Normal fluids noted
    If fluid shifts/renal reduce–>
    catheter and review hourly
    Check UEC, CRP, eGFR, haem regularly
  3. Mobilisation
    as early/much as can (not in
    epidural catheter,
    multiple injuries)
    Physio–> help flow, reduce
    DVT risks
  4. Communication
  5. Respiratory
  6. Fluid balance
  7. Gut function
  8. Drain and catheter care
22
Q

Respiratory considerations

A
  1. Control of pain
  2. Regular hyperinflation with inhalation spirometry
  3. Early mobilisation
23
Q

Gut function considerations

A 
1. Gastric dilitation: 2-3 days post-->massive fluid secretion, risk of regurg and aspiration
Insert NGT and decompress
2. Paralytic ileus: first post op
following peritonitis or 5 days post. Abdominal distention and vomiting
a. Oral fluid restriction
b. IV replacement
c. Most resolve spontaneousl
d. May consider pro-kinetic agents
3. Pseudo-obstruction:
elderly who has surgery
for fractures NOF
a. If not resolving spontaneously, 
colonoscopic decompression
24
Q

Principles of fluid balance

A
  1. Correct abnormalities
  2. Provide the daily requirements
  3. Replace any abnormal/ongoing losses
25
Q

Daily requirements

A 
basic requirements
45-60% TBW
2/3 intracellular
1/3 plasma water 
(25% of extracellular fluid) and
 interstitial
fluid (75% of extracellular fluid).
Na and potassium daily
requirements:
100–150 mmol and 60–90 mmol-->will balance loss in urine
Daily requirement for
maintenence 2-3L:
Loss: 1500 mL in the urine and about 500 mL from the skin, lungs and stool
26
Q

What do you need to do prior to potassium supplementation

A

Need to ensure kidneys are functioning

27
Q

Approximting losses from gastric, duodenal, diarrhea, upper GI, lower

A 
Gastric--> +chloride, 
sodium, small potassium
Duodenal/biliary/
pancreat/jejuno/feces--> mostly
Na, Cl and bicarb
Diarrhea--> Na, Cl, potassium and
bicarb
Upper GI-->acid lost (metabolic
alkalosis)
Lower-->sodium and bicarb
28
Q

Management of wound dishiscience and evisceration of the ward after laparotomy

A
  1. Assume defect involvles whole of the wound
  2. Put guts in abdomen, sterile dressing
  3. IV cannula, IV antibiotics, IVF
  4. Get senior help
  5. Let theatre know
  6. Analgesia

General surgery (36 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions